An attractive idea, but not exactly a simple solution

Is it time to require “vaccine passports” and, if so, should the government issue them or should this be a private sector initiative?

Those issues and more are addressed in an essay by a pair a medico-legal scholars published online by The New England Journal of Medicine.

As with many issues at the intersection of these two “noble professions,” certified vaccine passports carry a number of complex considerations. For example, since it appears that the vaccination rate is lagging in poor communities — be they inner-city or rural settings — as well as among people of color, could such passports simply enforce discrimination?

Mark A. Hall, JD, from the Schools of Law and Medicine at Wake Forest University, in Winston-Salem, North Carolina, and the USC-Brookings Schaeffer Initiative for Health Policy, in Washington, DC; and David M. Studdert, ScD, LLB, MPH, from the Schools of Law and Medicine, Stanford University, pointed out that “… if history is a guide, programs that confer social privilege on the basis of ’fitness’ can lead to invidious discrimination.”

A troubling reality may be another stumbling block: if the goal of such passports is to provide some assurance about safety, can that be done without confirmation that the vaccines actually provide protection against emerging variants?

Or what about those who eschew vaccination on religious grounds? Awarding a passport to the vaccinated “will penalize people with religious or philosophical objections to vaccination,” they wrote. “Finally, we lack a consensus approach to accurately certifying vaccination.”

In the summer of 2020, the authors “elicited views from a nationally representative panel” to determine support for a proposed immunity passport — in that case, immunity proven by test — and found the nation pretty much evenly divided, although more people supported such passports for those involved in “high-risk work” or for “attendance at large recreational events.”

Worldwide, there appears to be support for use of some type of vaccination passport, with the most likely application being travel. Already, both the Federal government and state governments are imposing quarantine requirements, so a passport doesn’t seem a radical addition. Both Hall and Studdert cautioned that a passport needs to be distinguished from a mandate.

Governments can take the lead on travel policies, and such policies may spread to other settings, but in the case of social and recreational activities, “the case for government control is weaker, because frontline policy setting and implementation more naturally fall to private actors,” they wrote. “Allowing sports leagues, concert and sporting venues, clubs, restaurants, and bars some latitude to set rules that determine access on the basis of customers’ vaccination status would be reasonable; doing so may also serve wider efforts to encourage vaccine uptake. Although not in the driver’s seat, government will have to help steer. Private actors need standards and bounds, including clear directives barring uses of vaccine certification that constitute unlawful discrimination. More generally, government can help to mitigate inequities arising from private certification by boosting the supply and distribution of vaccines and redoubling efforts to reach underserved populations.”

As a final word, the authors cautioned that any vaccine passport policy is likely to change as more becomes known about the vaccines, the virus, the variants, and the public response.

Peggy Peck, Editor-in-Chief, BreakingMED™

Hall and Studder had no disclosures.

Cat ID: 150

Topic ID: 88,150,730,933,125,190,926,192,927,150,151,590,928,925,934